The difference between counselling, psychology & psychiatry

A client asked me the other day what the difference was between a psychiatrist, psychologist and me, a counsellor.

A psychiatrist is a specially-trained medical doctor and they can prescribe medications. A psychologist is a ‘head doctor’ and can, like a psychiatrist, diagnose clinical conditions, but they cannot prescribe drugs. Psychologists in Adelaide usually treat their patients with either Cognitive Behaviour Therapy (CBT) tools or Acceptance and Commitment Therapy (ACT) practices.

Both psychiatrists and psychologists are able to be seen through Medicare-funded schemes, but there are considerable gaps to pay over and above what Medicare covers. Also, you are unlikely to be seen by either a psychologist or a psychiatrist quickly — often there is a multi-month wait for an appointment. A qualified counsellor is trained and experienced in dealing with the holistic whole of a person, and may use a number of recognised, proven clinical approaches to help a client to achieve mental wellness.

In addition, you are likely to be able to see a counsellor quicker than either a psychiatrist or psychologist.

A counsellor like me works in a more holistic manner, within the agenda of the person who walks into the room, and in a tailor-made fashion. Both psychiatrists and psychologists are only likely to see you once a month, whereas a counsellor will probably be able to see you more often than that. Also, you don’t get a Medicare rebate with counsellors whereas you do with psychiatrists and psychologists. As counselling does not have access to mental health plans or private health rebates, you can be certain that your sessions remain completely confidential. No one need know about your consultations other than me, if that is important to you.

If you see your GP and get a Mental Health Treatment Plan, you can see a psychologist (or social worker) a maximum of six times, after which you either get another four sessions or you have to pay the psychologist the full $200+ fee per session. As it is, you will likely have to pay a gap between what Medicare pays the psychologist and what the psychologist charges; this is usually around $100-150 per session. I charge $80 per session, and I can almost guarantee that I can see you before a psychiatrist or clinical psychologist can find time in their calendar.

I work from a Solution-Focused perspective, which is a strengths-based way of looking at a person. I believe that you are the expert in your own life, you know what is workable or not and you should be the final judge of how you are going to achieve your goals. I work with you to uncover strengths and resources to help you create a better life for yourself. I don’t sit as some sort of expert in your life and tell you what to do. As someone once said, ‘would you prefer a therapist to guide you or to trust you?’

My background training in psychology saw me design and conduct an Honours research project into the ‘Possible Self‘. I very much subscribe to the view that just about anyone can live a different life if they have the right support structures and beliefs in place. It is my aim to help you uncover those support structures and resources, as well as plan your steps forward to step into that possible self.

Sharry, Madden and Darmody (2012, p. 10) drew up the following table to reflect the differences between a solution-focused therapist (of which I am one) and problem-focused therapists (irrespective of whether they are psychiatrists, psychologists or counsellors):

‘Problem detective’‘Solution detective’
Looks for ‘clues’ that will reveal deeper problems and diagnosesLooks for ‘clues’ that reveal hidden strengths and positive possibilities
Tries to understand fixed problem patterns in the client’s lifeTries to understand how positive change occurs in the client’s life
Elicits detailed descriptions of problems and unwanted pastsElicits detailed descriptions of goals and preferred futures
Interested in categorising problems and applying diagnosesInterested in the person ‘beyond the problem’ and in the unique story he or she has to tell
Focuses on identifying ‘what’s wrong’, ‘what’s not working’ and on deficits in individuals, families and communitiesFocuses on ‘what’s right and what’s working’ and on strengths, skills and resources in individuals, families and communities
Interprets and highlights the times the client ‘resists’ or is inconsistent in his or her responsesHighlights and appreciates any time the client co-operates or goes along with the therapist’s questions
Explores how trauma has affected or damaged the clientExplores how the client has coped with trauma and how he or she has survived its damaging effects

Source: Sharry, Madden and Darmody (2012). Becoming a solution detective (2nd Ed.). New York: Routledge.


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